Positive – in poverty (HIV and the streets)

By Amanda Waldroupe, Staff Writer

If it were not for Adam Kutrumbos, 48-year old Brent Pitchford says he “would be wandering around like a lost duck.”

They met almost one year ago. Adam is a client advocate for Cascade AIDS Project’s CareLink program, which works with people newly diagnosed with the human immunodeficiency virus, or HIV, including low-income and homeless people who have little or no medical care.

Brent wrote a letter from the Oregon State Penitentiary where he was serving a 20-month sentence for a sexual offense charge. HIV positive for the last 15 years, Brent asked Adam what services would be available to him once he was released on Dec. 7.

So began a yearlong exchange through letters (Oregon prisoners do not have access to e-mail and are rarely allowed to use the telephone). They began Brent’s applications to the Oregon Health Plan and CareOregon for health insurance, his Social Security disability application, and finding a doctor.

Adam never wrote that he worked for CAP during the correspondence, knowing that Brent’s mail would be read by others. Working through mail presented other difficulties. Many topics and documents Adam and Brent discussed were complicated and required thorough explanation that would have been less stressful with a phone call or meeting.

“(I’m thinking) how many phone calls and how many more letters is this going to take? How am I going to say this correctly without ruining any confidentiality?” Adam says.

Adam repeatedly requested that the Department of Corrections send him Brent’s medical records, as well as certification that he is HIV positive (such information is not given directly to the inmate). With a requirement that people in the CareLink program be HIV positive, Adam needed substantive proof.

According to the Multnomah County Public Health Department, approximately 4,000 people living in the Portland area have HIV or AIDS. 2010 data shows that 15.5 percent of that population was homeless at some point during the previous 12-month period. For the first time in 10 years, CAP and service agencies serving homeless youths — Outside In, Janus Youth, New Avenues for Youth, and the Sexual Minority Youth Resource Center surveyed homeless youth in early 2010 about HIV risk and prevalence among that population. The final report is expected to be released in the next few months.

Since being released, Adam has helped Brent connect to resources, job options, food pantries, clothing closets and other services.

Brent also found out about the HIV Day Center through Adam. The Day Center is operated by Ecumenical Ministries of Oregon. Lindsay Ross-Hunt, the program manager of the center, says they serve approximately 260 people each year, and serve 9,000 meals. She says those numbers are increasing “more than ever before” because of the economic decline.

The Day Center takes up a large basement in a NE Portland church, and provides breakfast and lunch meals, access to telephones and computers, job resources, and respite during the day.

Brent spends many days there if he is not looking for a job or at the doctor. “It’s quieter here,” he says, than his room at the Shoreline, a single resident occupancy building downtown providing rooms to people recently released from prison for up to three months.

The impact Adam has had on Brent’s life in the brief period of time he has been released has been enormous.

“He’s been there when I needed to talk to someone. If it wasn’t for Adam, I wouldn’t have had any of the (things I have),” Brent says.

Life for Adam’s clients is filled with uncertainties. During the first two weeks in February, Adam is nagged by the fear that one client will be evicted. The client is on Social Security disability, and routinely loses the debit card allowing him to access those funds. He had lost the card again and cannot pay his rent. He told Adam he had ordered a new card, but it would take up to five to eight business days.

“Tomorrow is, like, the day,” Adam says on Feb. 10, when the client needs to pay the rent to prevent eviction. “It could be a good or a bad day, tomorrow.”

The client has a severe mental illness, and Adam normally checks in with him every day. But the client stopped returning Adam’s phone calls. Adam can’t find him when he goes by his room, sometimes twice a day.

“Every day, I‘m checking in on him,” Adam says, who grows increasingly frustrated and worried. “I’m saying, come check in with me! Let me know what the deal is!”

Then, days later, the client told Adam that the debit card arrived and he would pay his rent that day. One crisis averted, at least for another month.

Adam, 28, works with up to 20 clients at a time, many of whom have not accessed care for months, even years. Many are homeless or with extremely low incomes, have been recently released from prison, and suffer from mental illnesses or drug addictions. Fluent in Spanish, Adam also works with immigrants and others speaking Spanish as their first language.

He helps clients find housing, access medical care, get health insurance, obtain identification or birth certificates, and teaches them about HIV, its effects, its transmission, and sexual health — services and resources that help stabilize their lives, and manage their illness.

“I’m the welcome wagon. I’m getting that care and linking it right up,” Adam says. That can mean making sure the most basic tasks are completed, including accompanying a client on the bus to the hospital to ensure the appointment is made on time. Whenever there are checks involved — to pay the rent, pay for a new birth certificate, etc. — he goes with the client.

Living with a chronic, debilitating, potentially terminal disease like HIV demands that people take meticulous care of themselves to survive, and some of his newly diagnosed clients have the stability to do exactlky that. But for clients with significant mental illnesses and drug addictions, who Adam spends most of his time helping, their barriers prevent them from caring for themselves.

“I’ve got people I’m waiting to help and saying, ‘It’s not going to be quick, but these are the steps we’re going to take, and I’m going to help you through every step.’ They’re gone, and they don’t come back to see me. That happens every day.”

He wonders if he did something wrong, or if clients have become so disillusioned from working with various social-service agencies that they are unwilling to think he can help.

Many of his clients don’t manage their disease because it may not make them feel sick all of the time or appear to need immediate attention compared to caring for basic needs.

“You’re not oriented toward long-term consequence thinking,” says Barbara DiPietro, the policy director for Health Care for the Homeless, a national membership organization of health clinics serving homeless and low-income people. “Then what happens to you in 15, 20 years combined with the risks of living on the streets that day?”

“They end up dealing with it after they get really, really sick, and then are forced to do deal with it,” says Margie Robinson, the director of Multnomah County’s  HIV Care Services. “There are ways to make it not as bad,” if people are wrapped into the system early enough, and start — at the very least — going to a doctor regularly.

The tough reality, as Adam has found, is that helping high-barrier people living with HIV/AIDs is slow and arduous. An eternal optimist, full of energy and a ready smile, Adam believes “anybody can turn over a new leaf. That is how I logically approach my job.”

He has to — because if he despairs, his clients may have nowhere else to turn.

Brent discovered he was HIV positive 15 years ago after going to the doctor with complaints of feeling abnormally weak and tired. “I was getting real sick,” he says. “I lost 45 pounds.” His initial reaction, like the reactions of many of Adam’s clients, was the panicked, frightened belief that he would soon die.

“People were dying right and left,” Brent remembers. “I didn’t believe (that I had it). Then I was like well, OK, it’s something I have to live with.”

Today, people can now live with HIV for decades, rather than months or a few years.

When Brent was first diagnosed, he says he took a drug cocktail of eighteen pills a day. HIV is treated with drugs that prevent a person’s viral load, or quantity of the HIV virus in the person’s bloodstream, from becoming so high that it compromises the immune system and becomes AIDS.

HIV drugs have advanced considerably since then. While Brent was in prison, he took two pills a day. Brent’s new doctor, who he has seen since his release, has changed his medication twice. He now takes one pill.

Telling newly diagnosed HIV clients to stay on their medication is something Adam stresses. “If you don’t, your body can get used to it and the virus builds up,” he says.

A medical regimen that seems routine to housed people living with HIV/AIDs becomes more difficult and challenging for homeless people living with the disease. The disease demands a highly structure life: seeing a doctor every three or four months for blood tests; taking multiple medications multiple times a day, sometimes during a meal, or a certain period of time before or after eating; eat nutritiously, get regular sleep, etc. That all becomes difficult, if not impossible, for homeless people given the unstable and uncertain nature of homelessness — not knowing where one will sleep from one night to the next, or for how long; whether they will be able to eat three meals in one day; where to store their belongings, whether they will be stolen, etc.

“It’s harder for you to maintain appointments, timeliness, catching a bus,” says DiPietro. “Maintaining any structure you need to have is more difficult.”

Medications can expire, become ineffective, or be stolen. Not taking medications can mean that the HIV or AIDs virus will progress. Other illnesses also can become worse. Cuts can easily become infected without clean water, soap and antiseptics. It is more challenging for people with HIV and AIDs to fight infections and communicable diseases, and the infections could thus lead to more serious illnesses.

Not getting regular sleep, eating nutritiously and maintaining hygiene can also attack the immune system.

Greg Kendall, 44, lives at the Biltmore, public housing owned by Central City Concern. He has lived with AIDs since 2001. He says the living conditions there are “very detrimental to a person living with HIV/AIDs. … “I was losing so much sleep,” Kendall says.

He has had a bad cold for two weeks, which he attributes to sleep loss. He also says there is urine or feces smeared on toilet seats or other areas of the bathroom frequently. There is also no soap in the bathroom. He recently developed a urinary tract infection.

Colds and urinary infections are easily treatable and do not have long-term consequences for people without HIV/AIDs, but for those who do have it, such illnesses can be dire.

“Your illnesses start exacerbating your white blood cell count,” says DiPietro. “If you don’t have any immune ability to counteract that, that’s going to lead to a hospitalization pretty quickly.”

Someone living with HIV or AIDs may simply feel sick and want to lie down. “Not all shelters allow you to be there during the day,” Robinson says.

Brent feels tired and weak more often, despite the medication he is on. It directly affects the sort of job he will be able to have. He looks everyday for a job at a restaurant or a warehouse, and works with CAP’s employment program. He has ruled out working outside of Portland because of how long it takes to get there on public transportation.

“I’ve been really frustrated and mad. I’m starting to lose my patience,” Brent says.

He is also applying for Social Security benefits, but recently learned the application was denied.

Ted Amann oversees the social service agency Central City Concern’s Benefits and Entitlements Specialist Team (BEST) program, which helps homeless and low-income people apply for Social Security benefits. Whether the Social Security Administration approves a disability application for someone who is HIV positive has changed dramatically since the disease was discovered, Amann says.

Twenty or 30 years ago, “it was pretty much sort of a given that … you had a very limited life span. They would very quickly get approved for disability,” Amann says. “(Now) just having HIV in and of itself now is not automatically disabling.”

Applications require additional documentation of any additional illnesses or symptoms caused. “You have to show why it keeps you from working,” he says.

Brent’s application is currently in the appeal process, which could take up to a few months.

But time is running short for him to find an income. His housing at the Shoreline is temporary, and he must move by March 7. There is a possibility his parole officer will let him stay there longer, but it is unlikely. He is on CAP’s wait list, but Adam says there are 90 people on it.

Brent is not afraid of becoming homeless, but says that if he does, he might as well just give up. “When that time comes, I’m shutting down. You can’t look for a job when you’re homeless,” he says.

“March is just around the corner,” Adam says. “I’m totally afraid that he’s going to have to do some nights, weeks, months in shelters.”

The question of whether Brent will become homeless, and whether Adam’s clients can solve their individual problems, speaks more to the gaps in Portland’s social service system than anything else, Adam says.

Why couldn’t Brent, for example, simply stay in the Shoreline longer?

“(When I moved to Portland), I was on Craigslist every day looking for work. But it is super hard to find a job in three months,” Adam says. “Imagine someone with almost every barrier stacked against them with that pressure. And get it all done in three months?”

The fact that Brent is a felon with a sexual offender charge will always show up on housing or job applications. There isn’t enough housing that will accept sexual offenders, Adam says.

The federal Ryan White funding Multnomah County receives for HIV services mandates that 75 percent of the funds go toward medical care, case management services, medical, dental, mental and substance abuse treatment and care, and early intervention services (All of CareLink’s funding comes from this source).

The other 25 percent, Robinson says, goes toward other services, including housing. A believer that housing is a part of health care, Robinson says she and her colleagues have advocated to federal funders that housing be made a part of those core services. It hasn’t gotten anywhere, Robinson says.

“One of the challenges with the Ryan White program is that we are very well aware that things like housing are absolutely critical for people living with HIV,” Robinson says.

There are other service shortages.

The 2010 Multnomah County data that showed that 15.5 percent of the county’s HIV/AIDs population experienced homelessness within the past year, also showed that 25 percent had a severe mental illness, 16.3 percent have a history of injection drug use, and another 16.3 percent have substance abuse problems.

“(Those) are high proportions,” Robinson says.

And when people are incarcerated or quit a treatment program over and over again, social services have to be there to pick up the pieces, or the cycle continues.

“People deserve a second chance. And maybe a third, and a fourth, and a fifth,” Adam says. “We say ‘pick yourself up by your bootstraps.’ Yeah, but what if your boots didn’t fit right to begin with, and you’ve got boots are giving you blisters every day? Damn.”

Photo by Amiran White

4 responses to “Positive – in poverty (HIV and the streets)

  1. Pingback: About Homelessness » Blog Archive » Friday News Roundup: Cub Scouts, Budget Casualties, and Local Counts

  2. Pingback: Portland gets funding for people living with HIV/AIDS on the skids | For those who can’t afford free speech

  3. Pingback: Street Roots receives top honors from Society of Professional Journalists | For those who can’t afford free speech

  4. This man is a child molester and a predator. I hope he rots.

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